An impact and embedded process evaluation of The Fifth Child community engagement strategy in northern Uganda

Publication Details

Author

Jayne Webster, Jeannie Annan and Dickson Malunda

Country

Uganda

Region

Sub-Saharan Africa (includes East and West Africa)

Sector

Health Nutrition and Population

Subsector

Health Services, Community Action Program

Gender analysis

Equity Focus

None specified

Evaluation design

Randomised Control Trials (RCT), Mixed Methods

Status

Ongoing 3ie Funded Studies

3ie Funding Window

Innovations in Increasing Immunisation Thematic Window

Context

Northern Uganda has been facing several challenges in meeting the health needs of its population. A decade after the 20-year civil war ended, maternal and child health services, such as immunisation, remain weak. According to the Uganda Demographic and Health Survey 2011, coverage of DPT3 in northern Uganda has remained stagnant at 73 per cent. The current health system does not effectively engage communities in identifying, tracking and following up on infants and children who drop out and default. Additionally, poor data management has hindered the identification of infants and children in low-coverage pockets, often corresponding with the hardest-to-reach-areas.

The award has been granted to International rescue Committee, United Kingdom

Research questions

Does facilitating active community engagement in defaulter tracing, planning and implementation of outreach with the help of a phone-based mobile-health data collection platform:

increase vaccination coverage?

reduce immunisation drop-outs?

increase the timely receipt of vaccines?

Methodology

The intervention includes a mobile phone-based health (mHealth) data platform that will facilitate access of healthcare workers and village health teams (VHTs) to up-to-date data and allow them to track individual immunisation status and local coverage rates. It also includes systematic engagement with community leaders and other key community groups in outreach planning, mobilisation and implementation. The community members will also be provided access to immunisation coverage data and performance monitoring of vaccine defaulter tracing using mHealth. Formal communication linkages between healthcare providers and communities will be nurtured through VHT home visits and improved immunisation outreach services.

This study uses the cluster randomised controlled trial method along with an embedded process evaluation and qualitative research methods. The evaluation design will use health facility catchment areas as the unit of randomisation. The sample size will comprise of 16 clusters per study arm with 55 children in the age group of 12-23 months per cluster. This will bring the total number of children covered as part of this study to 1,760. Vaccination cards will be used to verify and validate the immunisation status of the children. Self-reports will be used if cards are unavailable.

The study team will also use observations based on predetermined criteria to assess the quality of defaulter home visits by VHTs. Data will also be collected through focus group discussions and interviews with key stakeholders at the local, regional and national level (health workers, community leaders and members, programme staff, government officials, etc.)